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Open Debridement Alone Versus Open Debridement With Tendon Repair for Lateral Epicondylitis: A Comparison of Complications and 5-Year Reoperation Rates From a Large Insurance Database
Orthopaedic Journal of Sports Medicine ( IF 2.6 ) Pub Date : 2022-09-02 , DOI: 10.1177/23259671221120812
Jay Moran 1 , Stephen M Gillinov 1 , Christopher A Schneble 1 , Andrew E Jimenez 1 , Ravi Vaswani 2 , Joshua I Mathew 2 , Joseph E Manzi 2 , Allen D Nicholson 2 , Theodore A Blaine 2 , David W Altchek 2 , Lawrence V Gulotta 2 , Joshua S Dines 2
Affiliation  

Background:

Open debridement (OD) of the extensor carpi radialis brevis tendon, both with and without repair to the lateral epicondyle, are effective treatments for recalcitrant lateral epicondylitis. However, few comparative studies exist within the literature.

Purpose:

To (1) compare the 5-year reoperation rates of patients who underwent OD alone versus OD with tendon repair (ODR) and (2) identify the 90-day adverse event rates, total same-day reimbursement amounts, and national usage trends for these 2 procedures from 2010 to 2019.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The PearlDiver MUExtr database was reviewed for patients diagnosed with lateral epicondylitis who underwent OD alone and ODR or reattachment between January 2010 and December 2019. These patients were stratified into 2 cohorts: the OD cohort and ODR cohort. The 5-year reoperation rates were assessed and compared, and the incidence of 90-day postoperative complications and risk factors were identified. The number of ODs and ODRs performed each year and the mean same-day reimbursement amounts (in US$) for both procedures were assessed.

Results:

Overall, 41,932 lateral epicondylitis patients who underwent debridement were identified, with 17,139 OD patients and 24,793 ODR patients. There were no significant changes in the proportion of OD versus ODR procedures performed during the study period (P = .18). A significantly higher incidence of hematoma was seen after OD compared with ODR (0.19% vs 0.12%; P = .04), but ODR had a significantly lower 5-year reoperation rate than OD (2.8% vs 3.9%; P = .006), with an absolute risk reduction of 1.1% and a number needed to treat of 91. Finally, ODR ($1683.17 ± $12.15) had a higher mean same-day reimbursement than OD ($1479.05 ± $15.78) (P = .001).

Conclusion:

Both OD and ODR had low complication rates. The 5-year reoperation rates were low for both procedures, but they were significantly higher for OD. Over the 10-year study period, there were no significant changes in the relative percentages of OD versus ODR performed. ODR had a significantly higher mean same-day reimbursement.



中文翻译:

外上髁炎单独开放清创术与肌腱修复开放清创术:大型保险数据库中并发症和 5 年再手术率的比较

背景:

桡侧腕短伸肌腱的开放性清创术 (OD),无论是否修复外上髁,都是治疗顽固性外上髁炎的有效方法。然而,文献中很少有比较研究。

目的:

(1) 比较单独接受 OD 与接受肌腱修复 (ODR) 的患者的 5 年再手术率,以及 (2) 确定 90 天不良事件发生率、当天总报销金额和全国使用趋势这两个程序从 2010 年到 2019 年。

学习规划:

队列研究;证据等级,3。

方法:

对 PearlDiver MUExtr 数据库进行了审查,以查找在 2010 年 1 月至 2019 年 12 月期间仅接受 OD 和 ODR 或复位的诊断为外上髁炎的患者。这些患者分为 2 个队列:OD 队列和 ODR 队列。评估和比较 5 年再手术率,确定 90 天术后并发症的发生率和危险因素。评估了每年进行的 OD 和 ODR 的数量以及这两种手术的平均当天报销金额(以美元计)。

结果:

总共确定了 41,932 名接受清创术的外上髁炎患者,其中 17,139 名 OD 患者和 24,793 名 ODR 患者。在研究期间执行的 OD 与 ODR 程序的比例没有显着变化 ( P = .18)。与 ODR 相比,OD 后血肿发生率显着更高(0.19% 对 0.12%;P = .04),但 ODR 的 5 年再手术率明显低于 OD(2.8% 对 3.9%;P = .006) ),绝对风险降低 1.1%,需要治疗的人数为 91。最后,ODR ($1683.17 ± $12.15) 的平均当天报销高于 OD ($1479.05 ± $15.78) (P = .001 )

结论:

OD 和 ODR 的并发症发生率都很低。两种手术的 5 年再手术率都很低,但 OD 明显更高。在 10 年的研究期间,执行的 OD 与 ODR 的相对百分比没有显着变化。ODR 的平均当日报销要高得多。

更新日期:2022-09-03
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